lecture 1 intro to spinal cord Flashcards
What is SCI
damage to the spinal cord resulting in symptoms below the level of injury
DCML _______ location, ________ touch
–sensory or motor:
–cross:
–function:
–ascending or descending:
precise, discriminative
sensory
medulla
two-point discrimination, proprioception, vibration
ascending
Spinal Thalamic Tract
–sensory or motor
–cross:
–function:
–ascending or descending:
sensory
spinal cord
non-discriminative/crude touch, pain, temperature, itch, tickle, sexual sensations
ascending
Corticospinal Tract -
sensory or motor
cross:
function:
ascending or descending:
motor
pyramids
voluntary distal movements
descending
Most common between ages _____ and ____+
15-29 and 65+
Leading cause of traumatic mechanism of injury for SC:
MVA (38%)
Incomplete injuries generally have a ___________ life expectancy than complete injuries.
____________ (Tetraplegia/Paraplegia) tends to have a shorter life expectancy compared to ____________ (Tetraplegia/Paraplegia).
longer; tetraplegia; paraplegia
Cost of Care for SCI is inexpensive. T or F?
False; expensive
Spinal shock happens when?
A period of areflexia lasts ____ hrs.
Reflexes return gradually over ______ days. Can have hyperreflexia for ______ weeks after
immediately after SCI
24hrs.
1-3 days
1-4 weeks
SCI are named by (3)
spinal level of injury
anatomical location of injury in cord
completeness of injury
Lower cervical tetraplegia life expectancy is longer than higher cervical tetraplegia due to
phrenic nerve, diaphragm
The ______ was created by the International Standard for Neurological Classification of SCI injury to determine _______ _______.
ASIA; SCI level
The ASIA looks at motor and sensory levels bilaterally as well as sacral tone and sensation to determine: (5)
motor level of injury
sensory level of injury
neurologic level of injury (NLI)
complete or incomplete
zone of partial perservation (ZPP)
Above T12 indicate ______ injury and below T12 indicates ______ injury
UMN; LMN
No motor or sensory function was preserved in the sacral segments S4 to S5
A = complete
Sensory but no motor function is preserved below the neurological level and includes the sacral segments S4 to S5
B = incomplete
Motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade of less than 3
C = incomplete
Motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a grade of 3 or more
D = incomplete
Motor and sensory functions are normal
E = normal
motor level of injury,” doctors look for the lowest muscle group where the strength is at least ______, as long as the muscle group just above it has a strength of ______.
3; 5
sensory level of injury, clinicians note the pts. most _____ level with a normal light touch and pinprick sensation on both L and R to determine the level
caudal
dermatomes and myotomes caudal to the sensory or motor level that remain partially innervated are known as
zone of partial preservation (ZPP)
Both voluntary anal contraction (VAC) and deep anal pressure (DAP) need to be absent for a ________ spinal cord injury
complete
Anterior Cord Syndrome -
B loss of CST and STT
hyperflexion injury
Central Cord Syndrome -
UE’s more affected than LE’s, with varying º of sensory impairment, sacral sparing
stenosis
Brown Sequard Syndrome -
Ipsilateral loss of DCML and CST, contralat. loss of STT
Posterior cord Syndrome -
B loss of DCML
hyperextension injury
motor intact
Conus Medullaris Syndrome -
Mixed LMN and UMN
Cauda Equina Syndrome -
LMN, flaccid paresis, saddle anesthesia
UMN = ______ conus medullaris
LMN = ______ conus medullaris
above
below
LMN generally below ______
hypo/hyperreflexia
flaccidity/spasticity
increased/decreased tone/spasticity
-/+ UMN signs
flaccid/contracted bowel and bladder
T12
hyporeflexia
flaccidity
decreased tone/spasticity
-UMN signs
flaccid bowel and bladder
UMN generally above ______
hypo/hyperreflexia
flaccidity/spasticity
increased/decreased tone/spasticity
-/+ UMN signs
flaccid/contracted bowel and bladder
T12
hyperreflexia
increased tone/spasticity
+ UMN signs
spastic bowel and bladder
Which type of setting is described:
–ICU
–Floor
–1-3 weeks
–getting upright tolerance
–basic mobility
Acute Care
Which type of setting is described:
–4-12 weeks
–learning ADLs
–mobility
–wheelchair training
–bracing
– best for intensity
acute rehab
Which type of setting is described:
–usually patients with higher level SCI on vents
–or after flap Sx
LTACH
Which type of setting is described:
–community integration
–MSK injury prevention
–sports
outpatient
Secondary Complications of the Cardiovascular/Pulmonary:
– what level does this occur?
–PNA
–Aspiration
–diaphragmatic/respiratory muscle impairment
–PE/DVT
–BP management
– C4 and above
Secondary of Autonomic Dysreflexia
HTN (raise of 20-30 mmHg systolic)
Bradycardia
flushing due to vasodilation
Headache
Profuse sweating
Blurred vision
Dry pale skin due to vasoconstriction
Secondary Complications: MSK
motor loss
osteoporosis
overuse injuries
heterotopic ossification
osteomyelitis
Psychological Complications: psychological
adjustment to trauma and/or loss
higher depression rates
Secondary complication: GI/GU
UTI
reflexive bladder/bowel
flaccid bladder/bowel
Secondary complications: Integ
high risk for pressure injuries due to:
- decreased sensation
- decreased mobility
- decreased blood flow
Stages of Integ complications:
stage 1
stage 2
stage 3
stage 4
___________ persistent non-blancable discoloration with a dark wound bed due to prolonged pressure or shear. May evolve rapidly to stage 3 or 4
intact skin, non blanchable
partial thickness looks like blister or scrape
full-thickness, into subcu fat layer
full-thickness involving muscle or bone
deep tissue pressure injury
stage 1
deep tissue pressure
stage 4
stage 3
PT management: Acute Care
early mobility once medically stable
focus exam on sensory/motor function, respiratory function, skin integrity, PROM, BP fluctuations
interventions:
PROM/contracture prevention
skin prevention
BP management with change in pos.
edu./ basic mobility
within ______ hours, perform ASIA
72 hours
PT management: Acute Rehab
ROM, strength, outcome measures, functional mobility level
intervention:
aerobic capacity
skin management
ADLs/functional mobility
pain/spasticity management
education
sterngthenign
DME, w/c, bracing
PT management: LTACH
mobility as able
exam focus = same for acute care
interventions:
skin prevention or treatment *** usually here due to flap Sx
respiratory function
PT management: Out-patient
PT exam MSK/Neuro/Pulm/Integ integrity
knowledge of SCI and level of independence
interventions:
community reintegration/navigation
goal-directed activities: return to sport, childcare, work etc.
prevent MSK repetitive use injuries
overall strengthening
